A few years ago I found myself in a huge ballroom of a hotel just outside Chicago. It was at a special meeting of the American Academy of Pediatrics (AAP) that I discovered the AAP’s agenda of prioritizing early brain development.

The discussions centred on toxic stress (bathing the fetal brain, still under significant construction, in stress hormones), social determinants of health, the importance of reading to babies, starting at a very early age, and the delayed exposure of a developing brain to technology (no TV before age two for example)

There was absolutely no mention of the role of nutrition. I was flabbergasted.

Imagine my delight when I saw the official position of the AAP last month in a paper titled, “Improving Nutrition in the First 1,000 Days to Support Childhood Development and Adult Health” Finally, pediatricians allowed nutrition’s impact on early brain development onto the bus. It may be at the back of the bus, but at least it is on the bus!

Why the back of the bus? Because research shows that virtually all doctors support exclusive breastfeeding in the first six months of life. (The reality, sadly, is that only 22 per cent of babies are exclusively nursed for the first six months). But as the authors wrote in the AAP paper, “Although most pediatricians are aware that exclusive breastfeeding is the best source of nutrition for the first six months, dietary advice thereafter is less robust.”

Even if more pediatricians took the time to at least talk to new moms about the role of nutrition in early brain development with the same passion they do about as reading to babies, will that help? Sadly, the answer is only partially, because we also need obstetricians and family doctors to join this important mission with more intentional determination.

In a September newsletter from the Alberta College of Family Physicians to its members, it was stated that “adding omega 3 to infant formula has no consistently meaningful effects” on early brain development. This is not helpful.

The role of essential fatty acids during pregnancy and during the first 1,000 days was unknown until relatively recently. I have found http://www.DHAOmega3.org to be a superb, up-to-date and objective resource for moms who ask how much fish they should consume during pregnancy and lactation, or for vegan moms who want to rely on plant-based sources for DHA.

The first 1,000 days, starting at conception and ending by age two, provide a great opportunity for optimizing early brain development. Nutrition plays a crucial role in setting the stage, establishing scaffolding for the brain to work at its best … not only in childhood, but later in life.

During the first 1,000 days, during one of the most active periods of neurological development, one can picture the brain as a building surrounded by scaffolding and lots of construction noises going on, moment by moment by moment.

Of particular interest is the visual and auditory pathways; the development of the hippocampus where the stage is set for later learning and memory development; the myelinisation process which determines the speed of processing; the establishment of important neurotransmitters such as monoamines; and the development of the prefrontal cortex — an area which plays a key role in planning, attention, inhibition and multitasking.

Failure to provide adequate nutrition at critical periods of brain development can have lifelong effects. For example, prenatal and early infancy iron deficiency is associated with long-term neurobehavioural damage that may not be reversible. Maternal-fetal transport of iron is limited when a pregnant mom smokes or experiences hypertension. Obesity during pregnancy and maternal diabetes increase fetal iron demands.

Currently, AHS is doing its best to help doctors ensure that these patients gain the appropriate amount of weight during pregnancy. The Institute of Medicine also provides guidelines on the optimal weight gain during pregnancy. We also know that maternal obesity is associated with decreased breastfeeding initiation rates, delayed onset of full milk production and insufficient milk supply, resulting in a shortened duration of breastfeeding.

Regardless of what formula companies may claim in terms of attempting to mimic human milk with infant formula, there are far too many key nutrients and growth factors important for brain development that even the gold-medal-winning formula may lack.

Just how significant the impact of the first 1,000 days may be later in life if the mark is missed or if the target is only partially hit is unclear and highly controversial.

Educators lament the lack of resources to help teens cope with the stresses of school. Could it be that part of the discussion should look at better ways to care for a brain under construction in the first 1,000 days at least?

Dr. Peter Nieman is a pediatrician, author and health coach. For more information, visit drnieman.com.

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